Adapting STEMI care for the COVID‐19 pandemic: The case for low‐risk STEMI triage and early discharge

Abstract

The coronavirus pandemic has resulted in the need for rapid assessment of resource utilization within our hospital systems. Specifically, the overwhelming need for intensive care unit (ICU) beds within epicenters of the pandemic has created a need for consideration as to how acute coronary syndrome cases, and specifically ST‐elevation myocardial infarction (STEMI) patients, are managed postprocedure. While most patients in the United States continue to be managed in coronary care units after primary percutaneous coronary intervention, there is a robust literature regarding the ability to triage STEMI patients safely and efficiently with low‐risk features to non‐ICU beds. We review the various risk scores for STEMI triage and the data supporting their usage. In summary, these findings support an approach to low‐risk STEMI triage that does not come at the expense of quality patient care or outcomes, where up to two‐thirds of patients with STEMI may be able to be safely managed without ICU‐level care.

STEMI care 2021: Addressing the knowledge gaps

“…Subsequently, AHA Mission: Lifeline recommends increasing public campaigns to raise awareness about a heart attack's signs and symptoms during Covid-19 pandemic [50] . Finally, experts suggest triaging low-risk STEMI patients to step-down units to protect critical care beds for severe Covid-19 patients [51] .…”

E-Triage Systems for COVID-19 Outbreak: Review and Recommendations

“…Majority of the ED triaging studies proposed for COVID-19 rely on subjective measurements [ 54 , 55 , 56 , 57 , 58 , 61 , 63 , 65 ]. Just a few studies [ 59 , 62 , 64 ] use a scoring system to assess admission or severity level of patients. While scoring-based triage systems are deterministic, the accuracy of the involved rules must be validated using actual datasets obtained from EDs.…”

“…As the spread of COVID-19 increased the demand for intensive care units (ICUs), a system of rapid resource assessment is required in hospitals. It is also important to classify patients with critical conditions such as ST-elevation myocardial infarction (STEMI) and assess their need for ICUs, as this will provide more resources to admit COVID-19 patients [ 59 ].…”

A Review of ST-Elevation Myocardial Infarction in Patients with COVID-19

“…Risk scores such as CADILLAC and Zwolle have been validated in the non-COVID-19 setting to be useful in triage of low-risk STEMI patients and theoretically were even more needed during the pandemic. 37 …”